When Stakeholders Unite Against Tuberculosis

Stakeholders from government and non-governmental organisations are uniting against the Tuberculosis scourge which is silently ravaging Nigerians. ZIGWAI TAGWAI followed stakeholder activities to mark the 2018 World Tuberculosis Day and presents the report.

In commemoration of the discovery of TB bacilli on World TB Day 2018, the National Tuberculosis, Leprosy and Buruli Ulcer Control Programme (NTBLCP) partnered with Stop TB challenge Project, the Federal Ministry of Health, FHI 360, United States Agency for International Development (USAID), Koninklijke Netherlandse Chemische Vereniging (KNCV) Tuberculosis Foundation, World Health Organisation and Aids Health Foundation (AHF) to challenge and end TB by creating public awareness about its existence, symptoms, availability of free diagnosis and treatment through the following events.

The theme of this year’s commemoration is “Find And Notify All TB Cases In Nigeria” And TheSlogan “Wanted: Leaders For A Tb Free Nigeria.”

The NTBLCP was established in 1989 by the government of Nigeria to coordinate TB and leprosy control efforts in Nigeria and its mandate further expanded to include Buruli ulcer control in 2006, with a vision for a Nigeria free of Tuberculosis and Leprosy and a mission to save Nigerian lives, reach zero TB deaths and reduce the burden and impact of TB, drug-resistant TB and TB/HIV on Nigeria. It also has a goal of achieving a 50 per cent reduction in TB prevalence rate and 75 per cent reduction in TB mortality rate in Nigeria by 2025 through its quarterly advocacy visit to the state governments, head of health institutions and other key stakeholders in the prevention and control of TBL in the country and canvassing for support to the TBL control programs at all levels communication and social mobilization.

National Professional Officer, World Health Organisation, Dr. Ayodele O. Awe, stated in an interview with DAILY ASSET during the community awareness outreach at Utako Motor park in Jabi, Abuja, that the expectation and purpose of the laid out programmes to mark the World Tuberculosis Day is in multiple folds. He said there was the need to create awareness about TB in communities and let people know that treatment is available for free as several persons have experienced coughing for two weeks and more which is the duration period given to a person having cough before being determined a TB suspect, without realising they need medical attention.

Awe advised those who experience these symptoms for the stated period of time to visit the nearest health facility to his or her location as there are a number of them all over Nigeria and get tested, using the sputum sample to determine the presence of germs. He further offered reassurance that TB is diagnosable and curable.

At the venue of the community awareness creation, organisers provided a mobile truck (Wellness on wheels) which housed a Gene expert machine and a Chest X-ray machine used in carrying out free tests for as many persons who were available. There were immediate treatments also available after tests were carried out, including HIV screening by staff of the Aids Health Foundation (AHF).

Dr. Awe expressed satisfaction with the huge turnout of the people who he referred to as a mobile community whose administrative leaders have been supportive through the planning of the programme.

Officials of the Aids Health Foundation were also present to offer free HIV test and education on prevention, treatment and diagnosis.

According to a staff of AHF, over 30 people had come forward for testing with 30 minutes of the exercise.

A beneficiary of both the TB screening and HIV test said it was the first time he was being tested for both diseases.

“Na good thing wey dem do for here oh because dem don dey tell me make I go hospital go check myself since but I never go. As dem don follow me come house now, I tell myself say I must to do am. Wetin remain na to go call my other brothers,” he said in pidgin English.

Executive Chairman of the Nigerian Union of Road Transport Workers, Mr. Lawrence Fadipe, stated that he and his members were excited about the intervention especially the awareness about TB, which in time past was considered an abomination.

He noted that the park is a large platform for creating awareness and sharing information because there are drivers passing through, travelling from one state or city to the other with people from all over coming in and going out.

Despite the turn out recorded, Fadipe expressed regret that many of his members were not available to benefit as it was the beginning of a new week and expressed the hope that there would be another intervention.

One of the supervisors from the Federal Capital Territory Tuberculosis and Leprosy Control Programme said the purpose of the outreach was to sensitise and screen as many persons who availed themselves.

She said the Motor Park was chosen because they have been receiving a lot of patients from the park and Jabi area which she suggested might be due to their living condition as a number of these people live within the park without proper homes so their expectation was to be able to pick positive cases and treat them.

She however lamented that most of the people start treatment and stop half way either because they begin to feel better or as a result of unstable accommodation or location.

She however said steps were being taken to tackle that by following up patients using contacts obtained during the screening.

A staff of the Federal Capital Territory Public Health Department narrated how people shy away from the screening exercise because they are not well enlightened about it but also emphasised that prevention is better than cure “as we all breathe the same circulated air so when we fail to educate or do something to help those affected by TB, we all become victims. It is airborne.”

The Chairman, Board of Stop TB Challenge Project, Dr. Lovett Lawson, emphasised that it is past the era of continuous donor dependence and the discussion was to focus on creating awareness on the discovery of the TB Bacilli which infects over 500,000 persons and kills 100,000 yearly, as one TB case can infect over 20 to 50 persons, with only 20 per cent infected cases being detected and Nigeria being number two high budding country for TB in Africa and number seven in the world.

He also highlighted that there is poor awareness especially with Nigerian’s travel culture and TB cannot be eradicated in the world if it is not eradicated in Nigeria but to do this, funding for TB programmes cannot be overemphasised as foreign partners presently contribute sixty per cent of the funding and Nigeria, five per cent, leaving a gap of 25 per cent, which means the pressure is on foreign support.

The National Co-ordinator, NTBLCP, Dr. Adebola Lawason, stated that every Nigerian is responsible for making Nigeria healthy by looking inwards, mobilising local resources and getting input from the private sector as part of their corporate responsibility.

“About $336 million was budgeted in 2017 and only 30 per cent of the total amount has been gotten. These events serve as a medium to share the information about TB as a time bomb in our society and the need to tackle it as effectively as we did Ebola. More resources are needed, more advocates, sensitisation and persons committed to championing the course.”

A representative of Health Finance and Governance Project, Dr. Frances Ilika, spoke about the goal of the organization, being to ensure healthy lives, access to high quality patient care for all Nigerians, access funding for TB prevention, treatment, diagnosis and promote wellbeing for all at all ages in line with the number three Sustainable Development Goals.

She also stated that although 15 per cent of the National budgetary allocation was to go to health, no allocation has been made so far.

Ilika also explained that domestic funding is expected to take care of 50 per cent funding of TB programmes but presently, the government provides 9%, international funding 27%, leaving a 64% gap in funding. Challenges of low funding, low TB case finding, poor awareness in communities and even among health practitioners, weak advocacy and poor case reporting were also pointed out and suggestions such as public financing by the government, innovative financing by the private or Corporate sector, prepayment mechanism by including the full TB menu in the Health insurance scheme in Nigeria and external financing, improved allocation by government and ensuring that the money is released and well spent were given as solutions to some of the challenges.

On his part, Dr. Han Kang, Director of the Office of HIV/AIDS and TB, United States Agency for International Development (USAID), said that while we mostly focus on the question how much, questions of who, what and when are equally relevant in the fight against TB.

“Who, meaning it can be anyone around you; What can you do to help out, When referring to the fact that there is no time like now to act in order to maximise resources already in place effectively.”

He also mentioned that “Nigeria is a country of innovation and boldness” and USAID taps into that to promote TB service and benefit packages and help manage available finance.

President, Association for Reproductive and Family Health (ARFH), Prof. Oladapo Ladipo, explained that it must be ensured that better results are gotten from money spent because state structures, strategic plan and the NBTLCP are already available but dysfunctionality results in a system with a funding gap in managing TB.

“We have laboratories but what is the capacity of the laboratory attendants, have they updated their skill, do they have the where withal to carry out functions and are salaries being effectively paid. Nigeria has the resources, we need not die of TB. The national Assembly says there is a National Health Act in existence but first, that was as a result of protest,” he stated.

Dr. Femi Pitan, Head, Occupational Health, Chevron, disclosed that $7000 funding had been provided by Chevron for TB drugs in 2007 and a support for TB centre in Ikeja, Lagos.

He said Chevron had also donated 25 chest clinics in various states in Nigeria, with three more being worked on presently in Kano, Oyo and Rivers and that over 1000 jobs had been created through these efforts while training for over 100 laboratory attendants and supervisors was carried out in 2014.

“Clinics are fully funded and functional,” he said.

The Governor, District 9110, Rotary Club International, Dr. Wale Ogunbadejo, said his district carries out screening for over 500,000 persons nationwide, annually, but people are quite secretive about being TB cases because of the stigma attached to it and in Abuja, only one private hospital has a Gene Extract machine which is grossly inadequate.

He also stated that there is a need for capacity building, as knowledge is power.

National Professional Officer, World Health Organisation (WHO), Nigeria, Dr Ayodele Awe, questioned the funding and sustainability level by government at the federal, state and local government level.

“How much of the 15% allocation by the government is to be given for TB programmes?” he queried, and further spoke on the need for organised private sector support using an already functioning partner like Chevron, to pivot it and that established facilities should be located in areas where they are most needed and most patronised.

The launch of the Nigerian Parliamentary Tuberculosis Caucus which held at the National Assembly to serve as a forum for parliamentarians and other political leaders to complement efforts of other stakeholders to end TB in Nigeria was well attended by partners of NTBLCP, the wife of the Vice president and the wife of the President who both gave their support towards the fight to end TB in Nigeria. The Nigeria TB Caucus is affiliated with to the Africa Tb Caucus and the Global TB Caucus. The launch and call to action provides the opportunity to formalize the process of establishing the Nigerian TB Caucus and provide more information that will enhance effective engagement of its members.

The ministerial press briefing and launch of new pediatric Anti-TB formulations was well attended by relevant stakeholders.

Dr. Lovett Lawson advocated for more investment in TB awareness programmes while Prof. Ladipo stated that there is a need for high index diagnosis as TB affects fertility (pelvic Tuberculosis).

He advocated diverse mediums of awareness (religious institutions, TV, radio, prints in various Nigerian languages) on TB and available help centres, saying, “we can break the stigma of TB the same way we did HIV.”

The Minister of Health, Prof. Isaac F. Adewole, said that TB is the leading infectious disease world over, with Nigeria being amongst the fourteenth highest budding countries of TB and HIV as only 1 out of 4 cases is discovered and treated in Nigeria.

He lamented that the challenges of tackling TB were being under reported.

“TB is not acquired, it comes to you and no wall can protect you from TB. This is a war we have to wage together because no one is secure.”

The minister further spoke on the need to optimise Gene Expert machines and for states in Nigeria to purchase and have at least one Wellness on Wheel Truck which accommodates a mobile Chest X-ray machine and Gene Expert machine, accelerating TB case funding as he applauded the efforts of increasing the number of available of Gene Expert machines from 32 in 2010 to 390 in 2017 and TB case door to door awareness from 4,000 to 10,000.

Prof. Adewole promised to ensure that existing partners are mobilised to launch a media caucus in May to help demystify TB, the first lady’s caucus in June, innovation and creativity day with debates and prizes to be won by the best three in June. He also advocated for pre-employment and admission screening.

At the High-level round table discussion on sustainable financing for TB to proffer solutions to challenges of financing TB programs in Nigeria, to recommend ways to mobilize domestic resources to end TB in Nigeria and to discuss how to improve synergy among different stakeholders and leverage on each other’s resources to end TB in Nigeria; there were representatives from the private and corporate sector; Association of General and Private Medical Practitioners of Nigeria (AGPMP), Committee on AIDS, Tuberculosis and Malaria, House of Representatives, National Assembly, Health Finance and Governance project, KNCV Challenge TB Project, Rotary Club District 9110, National TB Training Centre (Dr. Labaran Shehu), AGBAMI Co-Ventures, Niger State Agency for International Events, SHOPS PLUS.

– QUOTE ME –

““The armed forces are not neutral,” he said, adding, “They collude with the armed bandits that kill people, kill Nigerians. They facilitate their movement. They cover them. If you are depending on the armed forces to stop the killings, you will die one by one. The ethnic cleansing must stop in Taraba State. It must stop in all the states of Nigeria, otherwise Somalia will be a child’s play. I ask everyone of you to be at alert and defend your country, defend your territory, defend your state. You have nowhere else to go.””– Former minister of defence, General T Y Danjuma speaking at the maiden convocation ceremony of Taraba state university in Jalingo, Taraba State.

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